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Lower GI Tract > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is more prevalent, UC or Crohn’s?

A

Both have equal prevalence

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2
Q

What tends to appear later on in life, UC or Crohn’s?

A

UC - 30’s

Crohn’s - 20’s

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3
Q

What does smoking increase the risk of, UC or Crohn’s?

A

Crohn’s

Protective in UC

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4
Q

Which is TH2-mediated, UC or Crohn’s?

A

UC

Crohn’s is TH1/TH17-mediated

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5
Q

Backwash ileitis occurs in which condition, UC or Crohn’s?

A

UC

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6
Q

Which commonly is associated with strictures, UC or Crohn’s?

A

Crohn’s

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7
Q

Which condition affects the mucosa and forms crypt abscesses, UC or Crohn’s?

A

UC

Crohn’s = transmural inflammation

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8
Q

Which condition has a cobblestone mucosa (when describing ulceration), UC or Crohn’s?

A

Crohn’s

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9
Q

In which condition can you get granulomas, UC or Crohn’s?

A

Crohn’s

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10
Q

In which condition can fistulas occur, UC or Crohn’s?

A

Crohn’s

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11
Q

Which condition typically presents with bloody diarrhoea + mucus, UC or Crohn’s?

A

UC

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12
Q

Which condition do you get faecal urgency and tenesmus, UC or Crohn’s?

A

UC

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13
Q

What size does the colon have to be before it can be called a toxic megacolon?

A

> 6cm

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14
Q

Name the three skin signs in IBD

A 
Clubbing
Erythema nodosum
Pyoderma gangrenosum (esp UC)
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15
Q

Name the three eye signs in IBD

A

Iritis
Episcleritis
Conjunctivitis

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16
Q

Name the three joint signs in IBD

A

Arthritis (non-deforming, assymetrical)
Sacroiliitis
Ank Spond

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17
Q

Name the three HPB signs in IBD

A

Primary sclerosing cholangitis + cholangiocarcinoma (esp. UC)
Gallstones (esp crohns)
Fatty liver

18
Q

Which do you have a higher risk of colorectal cancer, UC or Crohn’s?

A

UC - 15%

19
Q

What are abdominal and anorectal abscesses more common in, UC or Crohn’s?

A

Crohn’s

20
Q

What is malabsorption more common in, UC or Crohn’s?

A

Crohn’s

Fat = steatorrhoea, gallstones
B12 = megaloblastic anaemia
Vit D = Osteomalacia
Protein = oedema

21
Q

What bloods would you run to investigate UC? (4)

A

FBC: drop in Hb, raised WCC
LFT: drop in albumin
CRP/ESR raised
Blood Cultures

22
Q

What stool sample tests would you run in UC and Crohns? (2)

A

M, C and S (Microscopy, culture and sensitivity): exclude campy, shigella, salmonella

CDT (C. diff toxin)

23
Q

What imaging would you order for UC? (2 main, 2 special)

A

ABX: megacolon, wall thickening
CXR: perf

CT
Barium/gastrograffin enema (lead piping=no haustra, thumbprinting=muscosal thickening, pseudopolyps=regenerating mucosal island

24
Q

What is the criteria used to assess the severity of UC?

A

Truelove and Witts

Mild, moderate, severe

25
Q

What does the Truelove and Witts criteria take into account? (6)

A 
Motions
PR bleed
Temp
HR
Hb
ESR
26
Q

What is the management of acute UC?

A 
NBM
IV hydration
Hydrocortisone IV 100mg QDS + PR
transfuse if required
Thromboprophylaxis: LMWH

RCT’s show no benefit of ABx

27
Q

What are the four acute complications of UC

A

Perf
Haemorrhage
Toxic megacolon
VTE

28
Q

What therapy do you use if you see an improvement after an acute episode of UC or Crohns?

A

Oral prednisolone

29
Q

What therapy do you use if you see a regression after an acute episode of UC?

A

Surgical: ?Colectomy
Medical: ciclosporin, infliximab

30
Q

In mild to moderate UC, what oral therapies are used?

A

Mesalazine
Prednisolone 2nd line
Infliximab 3rd line

31
Q

What percentage of UC sufferers require emergency surgery at some stage?

A

20%

32
Q

What bloods would you run to investigate crohns? (5)

A 
FBC: drop in Hb, raised WCC
LFT: drop in albumin
CRP/ESR raised
Blood Cultures
Haematinics: Fe, B12, Folate
33
Q

What imaging would you request in Crohns (2 basic, 2 special)

A

AXR: obstruction, sacroiliitis
CXR: perf

MRI: pelvic disease + fistulas
Small bowel follow through: skip lesions, rose-thorn ulcers, cobblestoning, string sign of Kantor (narrow terminal ileum - little bit of contrast allowed through, looks like string)

34
Q

What is cobblestoning?

A

Ulceration and mural oedema

35
Q

What 6 parameters indicate a severe attack?

A

raised temp, HR, ESR, CRP, WCC

drop in albumin

36
Q

Mx of severe attack of crohns?

A 
NBM, IV hydration
Hydrocortisone IV + PR if rectal disease
Metronidazole
Thromboprophylaxis: LMWH
Dietician review
37
Q

What is the difference in acute management between UC and Crohns?

A

You don’t use Abx in UC

38
Q

What are the two supportive treatments for crohns?

A

High fibre diet

vitamin supplements

39
Q

What is 1st line medical therapy for crohns affecting:

1) ileocaecal region
2) colonic region

A

1) budesonide

2) sulfasalazine

40
Q

What is second line medical therapy for crohns

A

prednisolone

3rd-methotrexate
4th-infliximab

Lower GI Tract (11 decks)

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